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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009852
Report Date: 06/20/2022
Date Signed: 06/20/2022 03:54:15 PM

Document Has Been Signed on 06/20/2022 03:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MORA, EVELYN FCCHFACILITY NUMBER:
283009852
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
06/20/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Evelyn MoraTIME COMPLETED:
12:30 PM
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A case management inspection was conducted to the facility by Licensing Program (LPA) Leticia Rosales-Meza in response to an increase capacity application received by the Department on 04/06/22. The licensee is requesting a capacity of 14. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The facility is toured inside and outside. The facility’s operating hours are 7:30 AM to 5:00 PM, Monday - Friday.

The floor plan submitted by the licensee was reviewed and verified. The off-limits areas of the home is the master bedroom, and was made inaccessible by means of door knob slip cover and key locked door. The home was observed to be clean and orderly, and was at a comfortable indoor temperature of 68 degrees Fahrenheit. Electrical outlets are covered and drapery cords are not accessible. The children's bathroom is free of toxins. There is a working telephone in the home. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee has a current roster of children in care and has conducted an emergency drill within the past six months. There are no firearms in the home, and none were observed during the inspection. The children use the front yard and deck as the outdoor play area and it is completely fenced. The backyard and studio are "off limits". There are no bodies of water on the property. All licensing reports are public information and must be made available upon request for at least three years. Pediatric CPR and Pediatric First Aid cards expire 02/2024. The Saint Elena Fire Marshall inspected and granted the fire clearance on 06/14/2022.

The increase capacity to 14, as a Large Family Child Care Home is granted as of today, 6/20/22.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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